MEDICARE: SAMUEL JOSEPH DONHAM PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.013752	IL

General Provider Information

NPI Number	:	1245862580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL JOSEPH DONHAM PLPC

Provider Business Mailing Address
First Line	:	3565 W DICKENS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3616
Country	:	US
Telephone Number	:	773-860-3939
Fax Number	:

Provider Business Practice Location Address
First Line	:	3565 W DICKENS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3616
Country	:	US
Telephone Number	:	773-860-3939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	03/03/2026

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